Journal of Urgent Care Medicine

Billing for Midlevels: Your Questions Answered

One of the biggest challenges for urgent care practices is staffing. Midlevels are a great solution. As states pass laws giving midlevels more autonomy to compensate for physician shortages, however, there is some confusion on how to bill for these providers’ services. I will attempt to answer some of your billing questions. Do I need to credential my midlevels? Yes and no. This is dependent on your contract. For some group contracts, any new provider …

ICD-10 Changes for 2022

Every year on October 1, the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics release an updated ICD-10-CM Official Guidelines, as well as changes to the code set. This year there are 159 new codes, 32 deleted codes, and 20 revised codes, with a total of 72,748 codes to choose from. (Visit ICD-10-CM Official Guidelines for Coding and Reporting FY 2022 at https://www.cms.gov/files/document/fy-2022-icd-10-cm-coding-guidelines.pdf to see the entire document.) Three …

What the #$%^ is happening with EM Coding and Reimbursement?! – Part II

In the May issue of JUCM, we outlined what we were seeing with E/M coding levels utilizing the new AMA guidelines vs 2020 and 2019 levels. As COVID-19 visits steadily declined from January through June, we began to see a return to more “normal” urgent care visits. That was short-lived. July’s sharp increase in visit volumes was again driven by COVID-19! Here’s the update we promised. As a reminder, we saw E/M levels decline in …

Credentialing: Why Should I Hire a Professional?

In the words of Red Adair, “If you think it’s expensive to hire a professional to do the job, wait until you hire an amateur.” Credentialing dictates how you bill. Do I bill as a group? Should I credential my nonphysician practitioners (NPP)? Which place of service (POS) should I bill with based on my contract? These are all important questions. Did you know that in April of this year, an urgent care chain reached …

Can I Bill Patients for COVID-19 Vaccine Administration?

As practices start offering vaccinations for COVID-19 to their patients, we are getting a lot of questions about whether the patient can be billed for the administration. The answer is an emphatic No. The Office of the Inspector General has received complaints from patients about charges by providers when getting their COVID-19 vaccines. So, on April 15, 2021, the Principal Deputy Inspector General Christi A. Grimm issued a message regarding provider compliance with the COVID-19 …

New Technical Corrections Issued by the AMA Explained

On March 9, 2021, the American Medical Association updated the new evaluation and management (E/M) coding guidelines with technical corrections. These clarifications apply to the office visit codes 99202–99215 and are retroactive to January 1, 2021. In the past few months there has been industry confusion over whether a test can be counted under the data element for the E/M level when the practice is also billing for the test. The AMA has answered this …

Credentialing and Contracting: What to Expect When Expanding

For those trying to grow their urgent care business, conversations around payer contracting and credentialing (CC) can often be overwhelming and seem contradictory to the mission of On-Demand Care. Tammy Mallow, our resident Experity advisor on all things CC says she often finds herself being the perceived as a “dream killer” when educating owners to the inner workings of this process. Established groups often expect the payer rules to be the same as they were …

Last Minute Coding Changes for 2021

December brought us some last-minute coding changes. In some cases, this caused a small claim delay as clearinghouses and payers scrambled to update their systems. New ICD-10 Codes for COVID-19 Effective January 1, 2021, there are new ICD-10 codes for reporting COVID-19 related diagnoses. These codes replace the existing codes we are using that are not as specific. There are two other new codes: 81 (Multisystem inflammatory syndrome (MIS)); and 89 (Other specified systemic involvement …

FAQ: New E/M Guidelines

It’s 2021, and the new E/M guidelines for office visit codes are here. Hopefully, providers will feel some relief in the amount they need to document and can spend more time treating their patients. This month I’ll answer some of the questions I’ve received. Q. Do all three elements of medical decision-making (MDM) need to be at the same level for the code selected? A. No. Only the two highest elements need to be met …